For many people, however, the CPAP device is difficult to use, and research suggests that full compliance with the therapy is low.

So researchers at the Naval Medical Center San Diego decided to see whether sleep medication could help patients warm up to their CPAP therapy and help them fall asleep more easily.

In general, it had no effect, Dr. David A. Bradshaw and his colleagues report in the journal Chest.

The study included 72 men who were just starting CPAP treatment. Bradshaw's team randomly assigned the men to take Ambien, a placebo pill, or neither for the first two weeks of their CPAP therapy.

A data chip in the CPAP device recorded the patients' compliance.

In the end of the study, the men who took sleeping pills were no more compliant with their therapy than the other patients were. That doesn't mean sleep medication is useless for everyone with sleep apnea, however, the researchers say. Because many people with the disorder also have insomnia, it's possible that some could benefit from a short time on sleep medication, according to Bradshaw.

Overall, "our study does not support prescription sleeping pills for all new CPAP users," he said in a statement, "but OSA patients with insomnia symptoms might benefit."

But even in these cases, caution is in order, Bradshaw noted. One concern, he said, is the possibility of side effects from sleep medication, including daytime drowsiness and impaired mental function -- problems that commonly arise from sleep apnea itself and could be compounded by sleeping pills.

SOURCE: Chest, November 2006.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Older age increases risk of obesity surgery

Last Updated: 2006-11-21 15:14:57 -0400 (Reuters Health)

By Anne Harding

NEW YORK (Reuters Health) - People 65 years of age or older may think twice about having weight loss surgery, according to a surgeon who performs this operation and has studied the outcome.

"You've got to go into this knowing that the risks are very formidable and you and your family have to be prepared to take those risks," Dr. Edward H. Livingston of the UT Southwestern Medical Center in Dallas told Reuters Health.

In a review of more than 25,000 weight-loss operations, also referred to as bariatric surgery, performed nationwide in 2001 and 2002, Livingston and his colleague Joshua Langert found that complications rose as people aged, and showed a "steep increase" after age 65.

Livingston and Langert used length of hospital stay as a marker for surgical complications, which can include leakage of the stitches used to link together sections of the stomach or intestine; pneumonia; and a type of blood infection known as sepsis.

Among the 1 percent of patients in the study who were 65 or older, 20 percent spent a week or longer in the hospital after surgery, indicating that they experienced adverse events, while 3.2 percent died in the hospital. The researchers also found a greater risk of complications among men, people with electrolyte imbalances, and those with diabetes.

Complications of bariatric surgery also were high among people on Medicaid who were younger than 65, who are generally disabled and likely to be poor. Further analysis found the increased risk was mainly due their greater risk of having complications related to their obesity such as high blood pressure or diabetes.

Ironically, Livingston noted, people with obesity-related conditions have the most to gain from bariatric surgery, but also are more likely to suffer complications from the surgery.

While the study confirms the risks of obesity surgery in older patients and those in worse health, Dr. Clifford W. Deveney of Oregon Health & Science University in Portland notes, "it is not certain when the risks outweigh the potential gains."

He concludes: "We need to look at benefits in the vast majority of patients who survive their bariatric procedure to determine what an appropriate risk is for a given patient. These data will only come from prospective studies designed to assess long-term outcomes following bariatric procedures."

SOURCE: Archives of Surgery, November 2006.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.